Hispanics are now the nation's largest minority group. Concurrently, there has also been a dramatic increase in the number of Hispanic patients with end stage renal disease (ESRD), with a relative increase of 63% between 1996 and 2005. The Hispanic ESRD population will continue to undergo dramatic growth because of the increasing size of the overall Hispanic population, the high prevalence of diabetes mellitus, and the increased incidence of ESRD among Hispanics. Despite the magnitude of this problem, little is known regarding earlier stages of kidney disease in the Hispanic population. The Hispanic Chronic Renal Insufficiency Cohort (HCRIC) Study is an ancillary study to the multi-center NIDDK-sponsored Chronic Renal Insufficiency Cohort (CRIC) Study. The HCRIC Study successfully completed recruitment of 327 Hispanics with chronic kidney disease (CKD) in 09/2008 and is the first prospective longitudinal study examining risk factors for the progression of CKD and cardiovascular disease in a sizable cohort of U.S. Hispanics with a broad range of kidney dysfunction. This work is ongoing through support from the current HCRIC award (PI- Lash, 5 R01 DK072231) but is insufficient to expand the breadth of scientific inquiry to critical determinants of health among Hispanic individuals with CKD. By fully leveraging the highly successful recruitment of and extensive data collection on HCRIC study participants over the previous grant cycle, this competing renewal provides a unique opportunity to investigate central hypotheses regarding the health consequences of CKD among Hispanic populations that experience a disproportionate burden of kidney disease. This competing renewal principally addresses three Specific Aims, focusing on measures of frailty, nocturnal blood pressure, and sleep disturbances among Hispanics with CKD. In addition, this application seeks to extend data collection and follow-up for an additional five years in order to accomplish key longitudinal analyses. We believe that the renewal of the HCRIC Study and its continued close linkage to the overall CRIC Study provide an unprecedented opportunity to more fully explore both risk factors and mechanisms for CKD and cardiovascular disease progression among Hispanics. PUBLIC HEALTH RELEVANCE: Though the number of Hispanics in the U.S. developing kidney failure requiring dialysis is growing dramatically, very little is know about early stages of kidney disease in Hispanics. The Hispanic Chronic Renal Insufficiency Cohort (HCRIC) Study, the first long-term study of Hispanics with kidney disease, has enrolled 327 Hispanics with kidney disease with the goal of increasing our understanding of the factors responsible for worsening of kidney disease and its associated heart disease. A renewal of the HCRIC Study will allow us to explore additional important areas of health in Hispanics with kidney disease, improve our understanding of this growing and poorly understood public health problem, and potentially lead to the development of more effective ways to prevent and treat kidney disease in Hispanics.